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Aims and objectives This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Background Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. Design A systematic literature review. Methods The terms ' Releasing Time to Care' and ' Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, Pro Quest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. Results The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. Conclusion The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. Relevance to clinical practice This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients' and healthcare professionals' views and experiences of a pre‐ and post‐operative rehabilitation intervention (SOLACE), for patients undergoing surgery for early‐stage lung cancer. Background: Considerable post‐operative complications can occur after surgery. A specialist lung cancer service (SOLACE) was developed to optimise health and fitness levels prior to and following lung cancer resections, as well as reducing morbidity and mortality, and improving the physical and psychological well‐being of patients. Design: The design was an exploratory, descriptive qualitative interview study. Methods: Seventeen lung cancer patients and eight healthcare professionals were recruited from a large teaching hospital in South England. Data were collected through semi‐structured telephone and face‐to‐face interviews. Transcribed interview data were analysed thematically. The COREQ checklist was used to report on the study process. Results: The SOLACE service was positively perceived by patients and healthcare professionals. Patients valued the provision of tailored support/advice and peer support and reported benefits to their health and well‐being. Barriers to patient uptake of the classes included time constraints, motivation and access for patients who lived at a distance. Conclusions: There is benefit in providing a personalised approach through a pre‐ and post‐operative rehabilitation service for lung cancer patients. Virtual support may address equality of access to service for those who live at a distance from the hospital. Relevance to clinical practice: Introduction of a pre‐ and post‐operative rehabilitation service provided by specialist peri‐operative rehabilitation nurses and practitioners can yield positive outcomes for patients undergoing surgical treatment of early‐stage lung cancer. Engagement of key healthcare professionals, consideration of virtual follow‐up services and making patients aware of services could maximise patient uptake. Further consideration is needed of the best way to promote patient self‐management and long‐term continuation of patient rehabilitation in the community. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore nurses’ perspectives of language barriers and their impact on the provision of care to patients with limited English proficiency from diverse linguistic background. Design and methods: A qualitative descriptive approach was used. Using individual interviews and focus group discussions, data were collected from 59 nurses working in tertiary care hospitals in England. A thematic analysis was used to analyse the data. Findings: Three themes, “multi‐ethnicities and language barriers,” “the impact of language barriers” and “communicating via interpreters,” were identified. Communication was identified as the most important aspect of care provision and an essential component of a nurse's professional role regardless of the clinical area or speciality. Language barriers were identified as the biggest obstacles in providing adequate, appropriate, effective and timely care to patients with limited English proficiency. Use of professional interpreters was considered useful; however, the limitations associated with use of interpretation service, including arrangement difficulties, availability and accessibility of interpreters, convenience, confidentiality and privacy‐related issues and impact on the patient's comfort were mentioned. Conclusions: Language barriers, in any country or setting, can negatively affect nurses’ ability to communicate effectively with their patients and thereby have a negative impact on the provision of appropriate, timely, safe and effective care to meet patient's needs. Relevance to clinical practice: An understanding of language barriers can help nurses find appropriate strategies to overcome such barriers and, consequently, enhance the provision of effective care to patients affected by language barriers in any clinical setting in any healthcare system. The findings of the study have international relevance as language barriers affect healthcare provision in any country or setting. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity. Background: Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people’s longer-term experiences following LAGB insertion. Design: A narrative-based qualitative interview study. Methods: A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants’ experiences. Findings: Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery. Conclusion: Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long-term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction. Relevance to clinical practice: Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients’ needs when weight loss plateaus or weight is regained and intensify support during these periods. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore whether and how spatial aspects of children's hospital wards (single and shared rooms) impact upon family-centred care. Background Family-centred care has been widely adopted in paediatric hospitals internationally. Recent hospital building programmes in many countries have prioritised the provision of single rooms over shared rooms. Limited attention has, however, been paid to the potential impact of spatial aspects of paediatric wards on family-centred care. Design Qualitative, ethnographic. Methods Phase 1; observation within four wards of a specialist children's hospital. Phase 2; interviews with 17 children aged 5-16 years and 60 parents/carers. Sixty nursing and support staff also took part in interviews and focus group discussions. All data were subjected to thematic analysis. Results Two themes emerged from the data analysis: 'role expectations' and 'family-nurse interactions'. The latter theme comprised three subthemes: 'family support needs', 'monitoring children's well-being' and 'survey-assess-interact within spatial contexts'. Conclusion Spatial configurations within hospital wards significantly impacted upon the relationships and interactions between children, parents and nurses, which played out differently in single and shared rooms. Increasing the provision of single rooms within wards is therefore likely to directly affect how family-centred care manifests in practice. Relevance to clinical practice Nurses need to be sensitive to the impact of spatial characteristics, and particularly of single and shared rooms, on families' experiences of children's hospital wards. Nurses' contribution to and experience of family-centred care can be expected to change significantly when spatial characteristics of wards change and, as is currently the vogue, hospitals maximise the provision of single rather than shared rooms. [ABSTRACT FROM AUTHOR]

Aims and objectives To report the findings gained from interviews with hospital nurses and care assistants, regarding the impact of hospital manual handling policies on their role in maintaining and promoting patients' mobility. Background Older hospitalised adults often experience deteriorations in mobility, which are often partially caused by protective or custodial care practice and environments that promote patient dependency. Hospital-induced mobility loss may be conceptualised as a problematic source of iatrogenic patient harm, worthy of attention from a patient safety standpoint. Preventative rehabilitation nursing interventions have the potential to prevent mobility loss. Design Grounded theory study. Methods Data were collected in three clinical settings: general rehabilitation, spinal injuries and stroke rehabilitation. Semi-structured interviews with 39 rehabilitation staff were completed. Results Perceptions of hospital manual handling policy were described via four subcategories: policy as stimulus to improved practice; policy as divorced from reality; policy as threat; and policy as hindrance to rehabilitation. Conclusions Hospital manual handling policy was perceived negatively by some nursing team members both as a threat and as a barrier to patients' rehabilitation. Risk aversion, divided teamwork practices and overuse of patient handling equipment were matters of concern. Relevance to clinical practice Perceptions of hospital manual handling policy should be openly discussed by nursing managers and direct care providers. It is important to recognise that beliefs about and perceptions of policy will often impact later on staff practices and behaviours. Unintended consequences arising from dominant interpretations of manual handling policy must be acknowledged and risks identified. It is important that practitioners balance risk assessment and prevention of falls with patients' needs for mobilisation. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. Background Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. Design Cross-sectional mixed methods design. Methods Three groups were included: termination of pregnancy ( n = 19), antenatal ( n = 9) and never pregnant ( n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. Results Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. Conclusions How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. Relevance to clinical practice The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial. [ABSTRACT FROM AUTHOR]

Aims and objectives. To evaluate the effect of a stop smoking clinic on the quit rates of patients admitted to an acute in-patient unit. Background. The relationship between poor physical health and severe mental illness is well established. High rates of smoking appear to play an important causal role in the excess morbidity and mortality in this population. Stop smoking interventions for the general population are clinically effective and cost-effective. There is a small but promising evidence base for effective interventions to help people with a mental illness who wish to stop smoking but these have mostly been tested with community patients rather than acute in-patients. Methods. A service evaluation of a drop-in stop smoking clinic on an acute mental health in-patient unit was conducted. Patients' smoking status was measured at baseline and four weeks after their quit date using patient self-report and an expired breath carbon monoxide reading. Results. Over a six-month evaluation period, 46 patients set a quit date and 13 (28·3%) were abstinent at the four-week follow-up stage, verified by a carbon monoxide reading (χ2 = 33, df = 1, sig p < 0·0001). Conclusions. This small-scale evaluation has shown a drop-in stop smoking intervention to be feasible, acceptable and associated with positive outcomes; further research with larger, more representative samples is required. Relevance to clinical practice. Enforcing smoke-free legislation is a contentious issue on mental health in-patient units, and there is a paucity of research to guide nursing practice in this area. An admission period in a smoke-free environment provides a crucial opportunity to offer smoking cessation treatment. With appropriate resources, expertise and support, it appears possible to apply smoking cessation interventions that are successful within the general population to mental health patients during an acute admission. [ABSTRACT FROM AUTHOR]

Aim. To explore nurses' challenges in managing pain among ill patients in critical care. Background. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Design. Qualitative prospective exploratory design. Methods. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Results. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Conclusions. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. Relevance to clinical practice. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure. Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process. Design. Qualitative practitioner research study. Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied. Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic. Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service. Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group. [ABSTRACT FROM AUTHOR]

Aim. To explore patients' experiences of the symptoms of suspected wound infection in external fixator pin sites. Background. Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient-orientated assessment criteria. Design. Qualitative design, using grounded theory. Method. Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis. Results. Participants described three 'clinical states' of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected. Conclusion. This study provides insight into patients' experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient-orientated outcome questionnaire for pin site infection. Relevance to clinical practice. There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites. [ABSTRACT FROM AUTHOR]